Putting patients first

Nurse practitioner-led cardiac unit amongst first in Canada

There were some exciting changes to the medical cardiology coronary care unit (CCU) at Calgary’s Rocky View General (RGH) hospital in 2019. 


On February 1, 2019, the seven-bed unit, which treats patients admitted with heart problems, became one of the first in Canada to be led by nurse practitioners, health-care leaders with advanced training in nursing. 


Nurse practitioner Nancy Clark, who spearheaded the initiative and is now the clinic nurse practitioner lead for the clinic, says the model provides consistent care for patients, as there is now a dedicated team of professionals on hand with advanced knowledge in cardiology and the ability to diagnose and prescribe medication.

 
“We are the first in line to consult with the emergency room on cardiology matters,” she says. “We are available for all hours, covering all shifts. We see all patients.”


Rocky View’s cardiology program is one of the busiest in Calgary. The hospital has a 35-bed cardiology ward and seven-bed CCU. Prior to the change, it operated like most across the country, although it did have support from nurse practitioners, including Clark.  


But when the nurse practitioners weren’t on shift, the unit was dependent on extenders and clinical assistants to cover the load. These clinicians came and went, covering shifts in hospitals around the city.


According to Teresa Thurber, the executive director of critical care and women’s health at RGH, although care was excellent, it was difficult to ensure there was consistency and around-the-clock expertise for patients.   


This new model has solved these issues. Eight nurse practitioners with specialized training in cardiology look after the unit. There is always one, and often two, of these highly educated professionals on duty. 


They work in conjunction with a consulting cardiologist to ensure the critically ill patients have what they need. These professionals are responsible for the first line of care in the unit doing everything from assessments and urgent bedside consults to diagnostics and treatments. 


The nurse practitioners are also the first point of contact between the emergency department and the unit and provide cardiology consults for the emergency team. 


“This creates consistency and continuity in coverage,” says Thurber, noting despite the fact that the supporting cardiologist on the unit changes weekly, there are now professionals in place who “know the patients really well.”


Thurber says although data is preliminary, she expects it to show that patients are having better experiences and outcomes within the unit. She is confident there will be a reduction in length of stay and readmission rates for patients. Thurber is impressed with the nurse practitioners’ commitment and passion to the model. 


“We have an exceptionally wonderful group,” she says. “When we talk about putting our patients first, these providers are truly committed to doing that. They follow their patients from the emergency department to CCU or the ward and even into the community.”


Dr. Nakul Sharma, who has worked alongside the nurse practitioners as the lead of cardiology at RGH, agrees and notes that nurse practitioners bring a holistic approach to patient care. 


“There is improvement in patient care. They have gone above and beyond,” he says. “They bring a whole different angle to patient care. It was the right thing to do to have nurse practitioners in more of a leadership role.”


Members of the CCU hope the model will be expanded to others centres. To that end, Clark said the nurse practitioners are working on a research project with plans to publish in a peer-reviewed journal. The research project will include both data and the patient voice. 


Sharma says the next steps are to expand the model in Calgary and to train the health care professionals to do simple invasive tasks. 


Thurber is fully supportive. “I hope this is just the beginning for nurse practitioners,” she says. “They are a very skilled, dedicated group of practitioners.”


Nurse practitioners began working in cardiac surgery in Calgary in 2002. Their leadership expanded to medical cardiology in 2003. 


Clark was the lone nurse practitioner in cardiology for several years. Thanks in part to her leadership, leaders within the Department of Cardiac Sciences at the Cumming School of Medicine and at RGH recognized the benefit that nurse practitioners bring and supported the  groundbreaking initiative at the CCU.